The U.S. vaccination drive has failed to equitably reach people of all races, and the pause on the Johnson & Johnson Covid vaccine is halting key efforts to jab hard-to-reach minority populations. The J&J shot only makes up about 4% of the more than 189 million doses administered. But because it doesn’t require expensive refrigeration and is only one dose, it’s the vaccine of choice for programs aimed at inoculating people who are homebound, homeless, and whose jobs make it hard to schedule multiple appointments. These are groups disproportionately made up of the minority populations already lagging in doses. Tuesday’s call from U.S. health officials for a temporary halt on the vaccine because of rare blood clot concerns has already disrupted many outreach efforts across the country. The U.S. Federal Emergency Management Agency suspended all of its mobile vaccine units, which had set up camp in health-care center deserts in major U.S. cities. Pilot community vaccination centers and programs for homebound seniors are on hold, too. U.S. public health advisers concluded a meeting Wednesday on the J&J vaccine without a vote, effectively extending a pause on its use while they seek more data on the rare clotting side effect. The CDC’s Advisory Committee on Immunization Practices didn’t give a precise date for when they’ll reconvene to reconsider the vaccine, leaving J&J’s shot in limbo.
“If this is an extended pause, some of those very important outreach initiatives might have to be on hold and that could be an issue,” said Joshua Michaud, the associate director for global health policy at the Kaiser Family Foundation. Only 6 U.S. states have vaccinated 25% or more of their Black populations, compared to 39 that have done as well with White people, according to Bloomberg’s demographic vaccine tracker. The reasons for the discrepancies vary, but access is at least partly to blame.
In Massachusetts, the Commonwealth Care Alliance Tuesday paused its program to deliver J&J vaccines to about 20,000 homebound residents, of which only around 800 have already gotten shots. “I will say for 10 minutes it was an ‘Oh, s--- moment,”
Commonwealth Care Alliance chief executive officer Chris Palmieri said. The non-profit is now racing to figure out how to offer the two-dose Moderna Inc. and Pfizer Inc. vaccines instead. People whose appointments were canceled could see delays of up to two weeks, Palmieri said.
New York City also suspended its vaccination program for 23,000 homebound residents on Tuesday. The city is looking into offering transportation to sites with Moderna and Pfizer shots. It will also reduce the use of mobile or pop-up vaccinations sites.
The Bronx Rising Initiative, which has 50 mostly Black and Hispanic homebound seniors on its waiting list for shots, Tuesday paused vaccinations, too. Chief Operating Officer Jason Autar said the J&J vaccine was the gold standard for the program, which is already logistically complicated. “It would have alleviated our need to go back a second time around,” he said. The group is now assessing its options with health-care partners to determine how to proceed, Autar said.
Those most affected, other than seniors and disabled homebound New Yorkers, are “people experiencing homelessness, or those who have difficulty getting time off from work or other obligations and benefited from the J&J one-shot feature,” said Patrick Gallahue, a spokesperson for the city Health Department. Epicenter NYC, a news organization that has registered thousands of New Yorkers for vaccines, said restaurant workers — a group that is 44% Hispanic — have tough schedules for the two shot regimen. Around 20% of the Hispanic population in New York City has been vaccinated, compared to 36% of White people. President Joe Biden Tuesday said the U.S. has secured enough doses of the Pfizer Inc.-BioNTech SE vaccine and the Moderna Inc. shot to cover the country’s adult population. That doesn’t mean all 300 million people will be able to access those doses, said Dr. Leana Wen, an emergency physician and public health professor at George Washington University, who also previously served as Baltimore's Health Commissioner.
“Not having that tool certainly hinders vaccination efforts,” she said, referring to the J&J vaccine. It will also mean that primary care physicians and small pharmacies, which have built up trust in their communities, but lack sophisticated freezers, won’t be able to distribute the vaccine, either.
A March 30 Kaiser survey found that the J&J shot is the most popular among people who are hesitant to get vaccinated. The same Kaiser survey found that vaccine hesitancy among Black adults has dropped significantly in recent months, but around 7% of those surveyed said they would “definitely not” get the shot.
Because of that, it will be crucial that findings on the risk of the J&J be communicated to at-risk communities by people they trust, said Tene Hamilton Franklin, vice president of stakeholder engagement at Health Leads, one of six groups in the Vaccine Equity Cooperative, which focuses on vaccine equity in under-represented groups. The consortium works with community members, through existing organizations such as community center sand faith leaders, to educate people on vaccine safety and help them access shots.
“We have to regroup,” she said. “And you have to regroup with the appropriate individuals at the table that already have trust in these communities were vulnerable populations exist.”
By Jeff Green